Provider Demographics
NPI:1720245574
Name:DAVILA, JOSE RAMON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAMON
Last Name:DAVILA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13940 N US 441
Mailing Address - Street 2:SUITE 904
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-259-6646
Mailing Address - Fax:352-751-3222
Practice Address - Street 1:13940 N US 441
Practice Address - Street 2:SUITE 904
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-259-6646
Practice Address - Fax:352-751-3222
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN112391223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics